Provider Demographics
NPI:1275780553
Name:PLETICHA, JERILYN D (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:D
Last Name:PLETICHA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 3RD DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6383
Mailing Address - Country:US
Mailing Address - Phone:206-310-5309
Mailing Address - Fax:
Practice Address - Street 1:16421 3RD DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6383
Practice Address - Country:US
Practice Address - Phone:206-310-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8478172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist